If you or someone you know suffers from depression or manic depression (also known as bipolar disorder), you understand all too well its symptoms may include feelings of sadness and hopelessness. These feelings can also include thoughts of self-harm or suicide. Whether we have suicidal thoughts ourselves or know a severely depressed person who does, there are ways that we can respond with strength and courage.

Understanding Suicidal Thinking

The most important thing to remember about suicidal thoughts is that they are symptoms of a treatable illness associated with fluctuations in the chemistry of the body and brain. They are not signs of personal weakness or character flaws, nor are they conditions that will just "go away" by themselves. Depression and the depressive phase of bipolar disorder may cause symptoms such as intense sadness, hopelessness, lethargy, loss of appetite, disruption of sleep, decreased ability to perform ones usual tasks, loss of interest in once-pleasurable activities. Taken together, these symptoms may lead someone to consider suicide. However, with proper treatment the majority of people do feel better.

During severe depression, the systems that regulate emotion become disturbed. People in severe depression often think of things that are dark and sad. Physicians refer to this as selective memory—only remembering the "bad times" or the disappointments in life. This is a symptom of their illness, not who they are, and with proper treatment the person will start to remember good times and develop a more positive outlook. (top)

If You Are Feeling Suicidal

If you have begun to think of suicide, it is important to recognize these thoughts for what they are: expressions of a treatable medical illness. Don't let embarrassment stand in the way of vital communication with your physician, family or friends. Take immediate action and talk to somebody today. Remember, suicide is a permanent solution to a temporary problem.

When people don't understand the facts about suicide and depressive illnesses, they may respond in ways that can cut off communication and worsen feelings. That's why it is important to find someone you trust and can talk with honestly. It's also why your mental health professional is an important resource in helping you, and your family.

Some facts about treatment

There are many different medications and therapies available for the successful treatment of depression. Not all medications work the same on all people, so it may take time for you and your doctor to develop a treatment plan that’s right for you. Stick with it, and recognize that your doctor is your partner in this search.

Create a Plan for Life

Many depression-related suicides occur during the first three depressive episodes before a person learns that an episode of suicidal thinking is temporary. As people learn from experience that any given episode will eventually pass, the likelihood that they will actually act on suicidal impulses drops sharply. It is important to have a course of action ready before thoughts of suicide occur. Some people find it helpful to develop a Plan for Life. The Plan for Life lists warning signs you should watch for and actions to take if you
feel that you are slipping into suicidal thoughts. Your Plan for Life may include:

A description of medical diagnosis, not just your depression but any medical problems you may have. Include information about any medications you are taking.

Health insurance information

Contact information for a local suicide hotline

Contact information for your local DMDA support group.

Sample Plan for Life

Educate those you trust about your condition before it becomes a crisis so they can be prepared if they are called upon to help. Provide key support people with your Plan for Life so they can act quickly, if needed. Carry a copy of your Plan for Life with you at all times so you can refer to it or pass it along to someone else who might be helping you in a time of crisis. With all the phone numbers in one place, it will be easier for someone to help.

What You Can Do To Fight Suicidal Thoughts

Keep a journal to write down your thoughts. Each day, write about your hopes for the future and the people you value in your life. Read what you've written when you need to remind yourself why your own life is important.

Go out with friends and family. When we are well, we enjoy spending time with friends and family. When we’re depressed, it becomes more difficult, but it is still important. Visiting or allowing visits by family and friends who are caring and can understand may help you feel better

Avoid drugs and alcohol. Most deaths by suicide result from sudden, uncontrolled impulses. Since drugs and alcohol contribute to such impulses, it is essential to avoid them. Drugs and alcohol also interfere with the effectiveness of medications prescribed for depression.

Learn to recognize the earliest warning signs of a suicidal episode. There are often subtle warning signs your body will give you when an episode is developing. As you learn to manage your illness, you will learn how to be sensitive to them. This is signal to treat yourself with the utmost care, as opposed to becoming angry or disgusted with yourself.

Talk about suicide. Your ability to explore the feelings, thoughts, and reactions associated with depression can provide valuable perspective and reassurance to your friend or loved one who may be depressed. Talking about suicide does not plant the idea in someone’s head. Not everyone who thinks of suicide attempts it. For many, it's a passing thought that lessens over time. For a significant number of people, however, the hopelessness and exaggerated anxiety brought on by untreated or under-treated depression may create suicidal thoughts that they cannot easily manage on their own. For this reason, take any mention of suicide seriously.

If someone you know is very close to suicide, direct questions about how, when, and where he or she intends to commit suicide can provide valuable information that may help prevent the attempt. Do not promise confidentiality in these circumstances. It is important for you to share this information with the person’s doctor.

More Helpful Information

Recognizing Warning Signs in Others

Sometimes even health care professionals have difficulty determining how close a person may be to attempting suicide. As a friend or family member, you can't know for certain either. If you sense there is a problem, ask the person direct questions and point out behavior patterns that concern you. Remind the person that you care about them and are concerned. Talking about suicide with someone will not plant the idea in his or her head. If necessary, suggest that they make appointment to see their doctor and offer to go with them if you sense they would have difficulty doing it on their own. If you believe that immediate self-harm is possible, take the person to a doctor or hospital emergency room immediately.

Feelings of despair and hopelessness
Often times, people with depression talk about extreme, feelings of hopelessness, despair and self-doubt with those closest to them. The more extreme these feelings grow, and the more often they are described as "unbearable," the more likely it is that the idea of suicide may enter the person's mind.

Taking care of business
When a person is "winding up his or her affairs" and making preparations for the family's welfare after he or she is gone, it is a good chance they are considering self-harm or suicide.

Rehearsing suicide
Rehearsing suicide, or seriously discussing specific suicide methods, are also indications of a commitment to follow through. Even if the person's suicidal intention seems to come and go, such preparation makes it that much easier for the individual to give way to a momentary impulse.

Drug or alcohol abuse

A person with worsening depression may abuse drugs or alcohol. These substances can worsen symptoms of depression or mania, decrease the effectiveness of medication, enhance impulsive behavior, and severely cloud judgment.

Beginning to feel better

It may sound strange, but a person with depression may be most likely to attempt suicide just when he or she seems to have passed an episode's low point and be on the way to recovery.

Experts believe there is an association between early recovery and increased likelihood of suicide. As depression begins to lift, a person's energy and planning capabilities may return before the suicidal thoughts disappear, enhancing the chances of an attempt. Studies show that the period six to twelve months after hospitalization is when patients are most likely to consider or reconsider suicide.

What You Can Do to Help Someone

Among the many things you can do to help a depressed person who may be considering suicide, most involve simply talking and listening. Do not take on the role of therapist. Often times we just want someone to listen. Though this may be difficult, here are some approaches that have worked for others:

Express empathy and concern

Severe depression is usually accompanied by a self-absorbed, uncommunicative, withdrawn state of mind. When you try to help, you may be met by an individual's reluctance to discuss what he or she is feeling. At such times, it is important to acknowledge the reality of the pain and hopelessness he or she is experiencing. Resist the urge to function as a therapist, which can ultimately create more feelings of rejection for the person, who doesn't want to be "told what to do." Remain a supportive friend and encourage continued treatment.

Describe specific behaviors and events that trouble you.

If you can explain particular ways a persons’ behavior has changed, this may help to get communication started. Try to help him or her overcome feelings of guilt. Compounding the lack of interest in communication may be guilt or shame over having suicidal thoughts. If there has already been a suicide attempt, guilt over both the attempt and its failure can make the problem worse. It is important to reassure the individual that there is nothing shameful about what they are thinking and feeling. Keep stressing that thoughts of hopelessness, guilt, and even suicide are all symptoms of a treatable medical condition and reinforce the person’s good work in keeping with their treatment plan.

Work with professionals

Never promise confidentiality if you believe someone is very close to suicide. Keep the person’s doctor or therapist informed of any thoughts of suicide. If possible it is best to encourage the person to discuss it with doctors themselves, but you should be ready to confirm that those discussions have taken place. This may involve making an appointment to visit the doctor together or calling the doctor on your own. Be aware that a doctor will not be able to discuss the person’s condition with you. You should only call to inform the doctor of your concern.

Whenever possible you should get permission from the depressed person to call their doctor if you feel there is a problem. Otherwise it could be seen as "butting in" and may worsen their symptoms or cause added stress. Of course, if you believe there is a serious risk of immediate self-harm, call their doctor. You can work out any feelings of anger the person has towards you later.

Stress that the person's life is important to you and to others.

Many people find it awkward to put into words how another person's life is important for their own well-being. Emphasize in specific terms the ways in which the person's suicide would be devastating to you and others. Share personal stories or pictures of past events.

Be prepared for anger

The person may express anger and feel betrayal by your attempt to prevent their suicide or get them into treatment. Be strong. Realize that these reactions are caused by the illness and should pass once the person has received the proper treatment.

Always be supportive

A person who has thought about or attempted suicide will most likely have feelings of guilt and shame. Be supportive and assure the person that their actions were caused by an illness that can be treated. Offer your continued support to help them recover.

Take care of yourself

It is not uncommon for friends and family members to experience stress or symptoms of depression when dealing with a suicidal person. You can only help the person through their own treatment with encouragement and support. You cannot get better for them. Do not focus all of your energy on the one person, ask friends and family to join you in providing support and keep to your normal routine as much as possible. Pay attention to your own feelings and seek help if you need it.

Responding to an Emergency Situation

If someone is threatening to commit suicide; if someone has let you know they are close to acting on a suicidal impulse, or if you strongly believe he or she is close to a suicidal act, these steps can help you manage the crisis.

Take the person seriously. Stay calm, but don't under-react.

tInvolve other people. Don't try to handle the crisis alone or jeopardize your own health or safety. Call 911, if necessary.

Contact the person's doctor, the police, a crisis intervention team, or others who are trained to help.

Express concern. Give concrete examples of what leads you to believe the person is close to suicide.

Listen attentively. Maintain eye contact. Use body language such as moving close to the person or holding his or her hand, if appropriate.

Ask direct questions. Find out if the person has a specific plan for suicide. Determine, if you can, what method of suicide is being considered.

Acknowledge the person's feelings. Be understanding, not judgmental or argumentative. Do not relieve the person of responsibility for his or her actions.

Offer reassurance. Stress that suicide is a permanent solution to a temporary problem, reminding the person that there is help and things will get better.

Don't promise confidentiality. You may need to speak to the person's doctor in order to protect the person from him or herself.

Make sure guns and old medications are not available.

If possible, don't leave the person alone until you are sure they are in the hands of competent professionals. If you have to leave, make sure another friend or family member can stay with the person until they can receive help.

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In a Crisis?

Get Help Now.

If you or someone you know has thoughts of death or suicide, call toll-free 800-273-TALK (800-273-8255), the NJ Hopeline 855-654-6735 or 9-1-1 IMMEDIATELY. For any psychiatric emergency in New Jersey call your county crisis center, or go to a hospital emergency room. Other non-emergency sources of help incude your medical professionals, clergy, a loved one, or a frined. If not in crisis but need to talk, call the MHA NJ Peer Recovery WarmLine at 877-292-5588 (Hours M-F 8 am - 10 pm, Sa-Su 5 pm - 10 pm, holidays 3 pm - 10 pm).